Pushing drugs: how medical marketing influences doctors and patients

Science News, July 30, 2005 by Ben Harder

Ads aren't necessarily having a wholly negative influence, Kravitz and his colleagues note. "Direct-to-consumer advertising may have competing effects on quality, potentially both averting underuse and promoting overuse" of prescription drugs, the researchers conclude in the April 27 Journal of the American Medical Association.

"It's probably promoted use of expensive, brand-name medications, which are more likely to be heavily promoted ... than less expensive generic alternatives," Kravitz says.

Other studies support the notion that DTC ads translate into prescriptions. One 2003 investigation found that people visiting doctors' offices in Sacramento, were twice as likely to request a new prescription, and twice as likely to receive one, as were similar patients in Vancouver, British Columbia. The U.S. patients were nearly six times as likely as were their Canadian counterparts to have recently seen ads for most of the half-dozen prescription drugs that the study examined, reported a team of Canadian and U.S. researchers, including Kravitz.

In a more recent survey of 643 U.S. physicians, many attributed a double-edged effect to pharmaceutical ads. Nearly three-quarters of the doctors said that they believe that DTC ads inform people about medicines that might help them, and two-thirds of the doctors said that ads improve dialogue. One quarter of the ad-initiated doctor-patient conversations lead to diagnoses of treatable problems that might have gone undetected, the doctors report.

On the other hand, four-fifths of the survey respondents said that ads encourage patients to seek unnecessary treatments and don't fully convey the therapies' risks. Joel S. Weissman of Harvard Medical School and his colleagues posted the results of the survey on the Web site of Health Affairs in April 2004.

The pharmaceutical industry says that it recognizes its responsibility to be candid about drug benefits and risks. "Our communication with patients should really be thought of as direct-to-consumer education;' said Johnson & Johnson's chief executive officer William C. Weldon at a March meeting of the Pharmaceutical Research and Manufacturers of America (PhRMA) in Washington, D.C. "The framework we call DTC advertising may inadvertently minimize the importance and power of medicines and their risks," he said.

In the months since the PhRMA meeting, where Weldon was elected to head the trade association's board of directors, companies such as Johnson & Johnson and AstraZeneca have introduced new television ads that include recitations of circumstances in which patients shouldn't use the companies' products. Last week, PhRMA'S board gave preliminary approval to a set of advertising principles that encourage ads that "reflect balance between risks and benefits."

The new advertising trend has a backdrop of recent concerns about drug safety. Since last September, when the sudden recall of the pain medication Vioxx raised congressional concerns (SN: 2/5/05, p. 90), the Food and Drug Administration has sent numerous warning letters to drug manufacturers.